A visual online web form builder and secure web form hosting solution.
Watch the video to learn.
Most medical and health-based organizations require HIPAA-compliant forms to keep track of and transfer sensitive patient information. LuxSci's SecureForm Form Builder is a developmental tool that helps you organize, manage, and store all those forms in one place. The SecureForm FormBuilder provides easy Web form creation and secure hosting that's completely HIPAA- (Health Insurance Portability and Accountability) compliant. You can ensure the protection of your data during transmission because our hosted forms use encrypted text are accessible over TLS. FormBuilder also allows you to include custom CSS and Java Script to adjust the complexity of your security levels as needed.
Our form building and hosting services are ideal for contact, customer request, survey, and legal forms. Our forms are also responsive to mobile devices and designed to seamlessly collect digital signatures. You can start from scratch or with one of our templates as a guiding tool to create your form(s). All of our forms are also Wordpress-friendly and easy to update. Use LuxSci's SecureForm FormBuilder as a simple way to organize and automate your business. SecureForm FormBuilder provides the online security necessary for a safe and efficient practice.
Yes. FormBuilder is a WYSIWYG (what you see is what you get) editor with a tool bar that makes it simple for anyone to create basic or stunning Web forms. FormBuilder also includes templates you can use to get you going.
Yes. FormBuilder hosted forms are accessible over TLS, only.
Yes. You can embed your FormBuilder form in any existing website using an iframe.
Yes. You can either
Yes. Amazon AWS Cloud hosts FormBuilder forms. They can scale to vast numbers of concurrent viewers and are safe from underlying server issues affecting uptime or performance.
FormBuilder is built into SecureForm, so the forms you design in FormBuilder are automatically configured to send data to SecureForm. You do not have to do anything in FormBuilder itself to connect it properly to SecureForm.
Visual HTML+Form Editor: No HTML Skills Needed
Add Ink Signatures
Form Builder includes a tool where you can insert and customize one or more Ink Signature boxes in your forms.
Form Save and Resume
SecureForm FormBuilder supports optional save and resume for long forms. The form saved form data is encrypted and temporarily stored in your database.
Save and Resume requires that users enter a password that will be used to access the saved form data (no "account" is created ... this password is used for authentication and encryption). The user is given a link that can be used, together with the password, to resume working on the form where they left off.
You can configured how long these saved form links are valid and how strong the user passwords must be. Non-HIPAA accounts (e.g. low security accounts) can also choose to forgo the need for a password.
File Upload Input Fields?
Form builder allows you to add "File Upload" input fields to your form so that end users can submit files as well as other information.
Images Upload and Hosting
You can upload images for display in your web site form. These will also be securely hosted with your form.
Paste in an Existing Form?
If you have an existing form, you can copy and paste it into the Form Builder. The existing styles and look will be preserved as best as possible (all styles become inline styles on the elements).
Form Field Validation: Required Fields
Form Field Validation: Field Format
Form Builder can check text fields for valid:
AJAX Submission detects offline state
SecureForm FormBuilder submits your forms* using AJAX. If the form submission fails due to lack of connectivity (e.g. the user or offline or the server is down/inaccessible), then the end user is notified with a little pop-up and can re-try the submission. The filled-in form is not lost.
* Does not apply to forms with file upload fields, as file upload is not currently supported over AJAX.
New accounts ready in 1 hour*
Account term is month-to-month
Free 30-minute training call included
*for non-dedicated-server orders placed between 9am and 10pm Eastern Time, USA. Provisioning can be delayed due to issues validating orders.
Book 2 in the LuxSci Internet Security Series.
Created by Erik Kangas, PhDGet the HIPAA eBook
I am extremely satisfied with your security features and with the extent of knowledge of your support staff. You provide a solid, reliable service and also manage to continue to add more thoughtful features -- all at a reasonable price."
LuxSci has been a pleasure to work with. The level of support we've received from them has been top-notch. From the smallest user issue to complex custom work, LuxSci has delivered service far above what I expected. Best of all, uptime with LuxSci has been 100%."
You are exceeding expectations. I have been very impressed with your organization. From sales and billing to tech support, everyone has been very responsive and knowledgeable. Most problems are resolved during the first contact. Thank you for your dedication to service and excellence. I will be recommending you without hesitation."
As a dentist, I'm glad I found LuxSci to walk me through the process of becoming HIPAA-compliant! Once I signed up, Connie and Peter both helped me setup get situated with my secure email service. Getting my Business Associate Agreement also a snap. Thank you LuxSci. Now I can concentrate on treating patients!"
I wanted to congratulate you on your service; the reduction in Spam is incredible, and the speed of delivery is stunning. I am recommending you to all of my friends and associates! You can quote me on that!"